Utah Systemic Disease - Part II Flashcards
What are the direct effects of bacteria and bacterial products?
Release IL-1, IL-6, TNF-alpha
Result in vascular lesions
What are the indirect effects of bacteria and bacterial products?
Stimulate liver
Release CRP, fibrinogen, lipid abnormalities, coagulation factors
Result in vascular lesion
What are two well-established risk factors for cardiovascular disease?
Tobacco smoking
High LDL
T/F - CRP is an important risk factor for MI.
TRUE
What two things are there a relationship with cardiovascular disease?
CRP
Plasma fibrinogen
T/F - Periodontitis increased systemic CRP and fibrinogen.
TRUE
CRP levels increased in periodontitis
One year perio tx show a reduction of CRP
Atherosclerotic plaques pathogenesis include what 5 things?
Endothelial damage/dysfunction
Lipid deposition and oxidation in the sub-endo space
Macrophage/PMN chemotaxis
Smooth muscle proliferation
Plaque rupture
Where is CRP created?
By hepatocytes
T/F - People over age 16 have some atherosclerosis.
TRUE
Look at slide 9
Slide 9
It’s a chart
What is MCP1?
Monocyte chemotactic protein-1
—Member of the small inducible gene (SIG) family
What does MCP1 do?
Recruits monocytes to sites of injury and infection
Where is the gene for MCP1?
On chromosome 17
Where is MCP1 found?
In the jts of people with RA
Elevated in urine as a sign of kidney inflammation
Associated with diabetes
T/F - Macrophages express receptors that take up modified LDL.
TRUE
T/F - TNFalpha, IL-6, and IL-1 are also associated with chromosome 17 at the same locus (17q11.2-q12).
TRUE
Slides 12-14
Pictures
T/F - Macrophages and foam cells express growth factors and proteinases.
TRUE
The remnants of _______ and ________ are also proinflammatory.
VLDL
Chylomicrons
Plaque inflammation causes what 3 things?
Fibrous cap thinning
Plaque rupture
Thrombosis
Breakdown of plaque leads to what 4 things?
MI
Angina
Stroke
TIAs
T/F - Periodontitis has a role in atherosclerosis.
TRUE
Stimulation of cells with LPS, TNFalpha, and IL-1beta induces what?
NFkappaB
_________ stimulates macrophage activation and smooth muscle cell proliferation.
NFkappaB
Doxycycline does what?
Reduces CRP and fibrinogen to normal levels
Preventative maintenance therapy is aimed at reducing which bacteria?
P gingivalis
Minocycline does what for pts with increased risk of CVD?
Reduced CRP and TNFalpha
Do oral bacteria have a relationship to CVD?
YES
Directly increase risk for CVD and strokes
T/F - Poor dental health is associated with CVD.
We can’t clearly say though that severe periodontal disease will give you an MI.
TRUE
T/F - T forsynthesis and P gingivalis are assocaited with MI.
TRUE
T/F - There is an associated of periodontal disease and increased risk for CVD.
TRUE
T/F - Periodontitis is related to atherosclerosis.
TRUE
What are the 2 types of stroke?
Hemorrhagic
- Bleeding into brain
- Death is typically imminent
- NOT associated with periodontal disease
Nonhemorrhagic/ischemic
- Caused by blockage of a bv supplying the brain
- IS associated with periodontal disease
What should we do with CVD pts?
Conduct medical history and physical exam
ID physical signs and symptoms of cardiac dysfunction
Evaluate vital signs
Seek medical consultation when indicated
Know concomitant
Know conditions req ax prophylaxis
T/F - In men less than 50 yo, 25% fo pts who had a stroke had significant dental disease.
TRUE
T/F - Periodontal disease is a significant risk factor for non-hemorrhagic but not for hemorrhagic stroke.
TRUE
T/F - Only strokes associated with narrowing of the arteries (atherosclerosis) seem to be related.
TRUE
T/F - Estrogen and progesterone can be used by some bacteroides spp (G-), and P intermedia as substitutes for vitamin K, one of their important growth factors.
TRUE
T/F - Use of contraceptives also use gestational hormones that can also lead to increased gingival inflammation.
TRUE
T/F - Pregnant women have more gingivitis independent of plaque accumulation.
TRUE
It mirrors increasing estrogen and progesterone levels in months 4-9
This is reversible
Hormones are at high levels in the GCF
CT breakdown may be enhanced by ________ ________ activating the fibrinolytic system.
Plasminogen activator
Preterm birth occurs at what rate in the US?
1 in 8
Inflammation thought to account for 30-50% of all premature deliveries
More than ___% of babies in the US are born at a low birth weight.
8
What is leukocyte adhesion deficiency (LAD) due to?
Deficiency in cell surface integrins
Tell me about LAD.
Leukocytes cannot adhere to wall of endothelium at sites of infection
-No diapedesis or migration from capillaries into soft tissue
No migration to infectious site
Leads to death
T/F - Chediak-Higashi syndrome is related to an increased risk of periodontal disease.
TRUE
What is cyclic neutropenia?
Cyclical decrease in PMNs on a 21 day cycle and a 3-10 day period of severe neutropenia
3-6 days of fever, malaise, mood swing, oral ulcerations
Periodontitis may progress faster during PMN depression
Cyclic vs congenital neutropenia.
Cyclic - Due to genetics
Congenital - Present at Birth
Tell me about congenital neutropenia.
Low PMN count
Severe bacterial infections
Just remember that neutropenia, LAD, Chediak-Higashi Syndrome, Papillon-Lefevre Syndrome are systemic conditions that increase periodontitis.
Good
Tell me about Down syndrome in regards to perio.
PMNs normal
Chemotaxis, phagocytosis, and intracellular killing may be reduced
Collagenase and GCF PMNs may be increased
More at risk for periodontal disease
T/F - Sometimes the first sing of leukemia is seen in the oral cavity.
TRUE
Mucosal ulcerations and gingival enlargements
Tell me about Wegener’s Granulomatosis (Strawberry gingivitis).
Necrotizing vasculitis of small vessels of upper and lower respiratory tract
Hyperplastic gingivitis
Tooth mobility and tooth loss
Quiz Stuff for next week
PD (Periodontal disease) is inflammatory disease, associated with microbial flora
Increase in CRP, plasmin activators
if get health, lower those mediators
Inflammatory mediators have direct effect on systemic plaques, so increases risk of thrombosis
PD and CVD are related based on populations, looking at an individual, we can’t always assume that
Pregnant women are at an increased risk for gingivitis
Systemic diseases can cause periodontal disease, decrease PMN fx or decreased chemotaxis
Downs is at risk for PD
KNOW THESE
